Gastroenterology Coding Alert

Question: The physician's notes simply indicate "foreign body removal of pancreatic stent." I really don't think a stent would be considered a foreign body because it was for therapeutic purposes, but I may be wrong. What is the appropriate diagnosis code?

Kansas Subscriber

Answer: Use V53.59 (Fitting and adjustment of other gastrointestinal appliance and device) for stent removal.

Get your CPT right: If the physician performs an esophagogastroduodenoscopy (EGD) to remove the stent, the code to use is 43247 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with removal of foreign body). Generally this means that the stent has migrated out of the biliary or pancreatic ducts and is able to be retrieved via a standard endoscopy or the stent is being removed without the performance of either a cholangiogram or a pancreatogram.

If she does an endoscopic retrograde cholangio-pancreatography (ERCP) to remove the stent directly from the biliary or pancreatic ducts and perfroms either cholangiogram or a pancreatogram., the appropriate CPT code is 43269 (Endoscopic retrograde cholangiopancreatography [ERCP]; with endoscopic retrograde removal of foreign body and/or change of tube or stent), which would also include replacing the removed stent, if she did that at the same time.